手部痛风的手术治疗

目的 探讨手部痛风的手术疗效及诊治经验。方法 对16例手部痛风伴有结石、关节肌腱粘连及腕管综合征的患者，采用单纯痛风石切除5例，痛风石切除同时行肌腱粘连松解及部分指浅屈肌腱切除5例，痛风石切除、腕管切开减压正中神经或指神经松解6例。术前、术后1周内服用痛风利仙50mg／次，每日2次，西乐葆0．2g/次，每日1次。结果 术后全部病例均切除了痛风结石，同时纠正了手指的外形畸形，手指麻木症状好转，皮肤无坏死，伤口均Ⅰ期愈合。术后随访5个月～5年，未见痛风石复发，手指外形及功能满意。结论 手术治疗对痛风晚期进行痛风石清除有效，同时也可纠正畸形及外形，改善手功能。     

局部病灶切除辅助西药治疗痛风结石

目的应用局部病灶切除辅助西药治疗痛风结石。方法局部病灶切除术前或痛风急性发作时应用秋水仙碱或别嘌醇片，待血清尿酸≤300mmo／L可施行局部病灶切除手术。术后采用秋水仙碱维持量或减量予以辅助治疗。结果对25例应用局部病灶切除辅助西药治疗痛风结石，仅1例术后7个月复发，1例术后20个月复发，经内科治疗后病情缓解。其余20例均取得满意的效果。结论应用局部病灶切除辅助西药治疗痛风结石，可以有效控制痛风，清除病灶，减少复发痛风是尿酸盐沉积在关节囊、滑囊、骨质、肾脏、皮下、肌腱及其他组织中引起相应的病损及炎性反应的一种疾病。     

晚期手部痛风结石的治疗体会

目的探讨晚期手部痛风结石手术治疗的临床疗效及治疗经验。方法 2007年1月至2018年12月,对27例手部痛风结石患者,痛风石切除同时行肌腱移植15例,痛风石切除同时行关节融合12例,痛风石切除同时行关节融合及肌腱移植7例。术后1周内服用秋水仙碱,每日3次,每次0.5mg。结果术后全部病例均切除了痛风结石,同时纠正了手指的外形畸形,皮肤无坏死,伤口均I期愈合。24例患者获得随访,3例失访,术后随访6个月～3年,手指外形及功能满意,有2例手部痛风石复发。结论手术治疗能有效清除手部痛风结石,同时可纠正手指畸形及外观,改善手功能,是治疗手部晚期痛风结石的有效手段。     

保留皮肤的手部巨大痛风结石切除术

目的 探讨手术切除手部巨大痛风结石的可行方法.方法 14例患者的手部痛风结石均侵及肌腱、滑膜等组织,其中12例x线片湿示关节软骨有虫蚀样改变;采用手术切除痛风结石及指伸肌腱吻合术,用大量生理盐水反复冲洗伤口,放置橡皮片引流,尽量保留表面皮肤以覆盖创面.结果 全部患者均切除痛风结石,切口I期愈合.随访6-24个月,手外形得到明显改善;5例患者进行了指伸肌腱吻合,未出现皮肤坏死和切口延迟愈合.结论 对于手部巨大的痛风结石应当采用手术切除治疗,同时尽可能保留表面的皮肤.     

手术后痛风

目的　探讨手术后痛风发作的临床和实验室检查特点,以及药物治疗的效果。方法　回顾性分析1985 年8 月～1996 年12 月治疗的既往有痛风病史且经手术处理,和既往无痛风病史但出现手术后痛风发作的患者237 例的临床资料。结果　41 例患者出现手术后痛风发作,其中男36 例,女5 例。年龄为22 ～80 岁(55-2 ±3-1 岁) 。38 例既往有痛风病史,14 例能长期坚持服药治疗,其余24 例未能坚持治疗。3 例术后痛风为首次发作。术后痛风发作距手术时间为2 ～17(4-6 ±0-7)d 。受累关节分布以下肢为主。诊断明确后,采用非甾体类抗炎药或秋水仙碱治疗效果好。结论　手术后痛风容易误诊为一般手术后的炎症反应。对围手术期关节痛病人,无论既往有无痛风病史,均应测定血清尿酸水平,必要时可行关节滑囊液检查     

晚期痛风石患者的手术治疗

如果药物不能有效地控制痛风的发展，痛风石形成并沉积于手足等特殊部位，而影响功能、着装和美观时，即需要外科手术治疗。作者近来收治了３例患者，进行了６次手术，效果良好，对痛风石应手术切除以保护手足功能，一般术后伤口良好愈合，在术前及术后要注意药物控制，以避免痛风急性发作。     

上肢慢性痛风性关节炎的手术治疗

[目的]探讨上肢慢性痛风性关节炎手术治疗的可行性。[方法]对近8年来收治的21例慢性痛风性关节炎治疗进行分析。21例均行以手术为主的综合治疗，术中彻底清除尿酸盐结晶，去除受侵蚀的关节囊、肌腱、软骨及骨端松质骨，受损较重的指间关节行关节融合术，术前、术后采用内科综合疗法，降低血尿酸浓度。[结果]术后随访16例，随访时间1．5～3年。14例关节功能较术前改善，关节活动度增加，活动后不适感减轻；2例术后关节功能无改善，其中1例痛风石复发。[结论]上肢慢性痛风性关节炎采用以手术治疗为主的综合疗法是该病最佳治疗方法，对改善临床症状，保护关节功能尤为重要。     

分期手术治疗第1跖趾关节巨大痛风石的临床研究

目的:探讨分期手术治疗第1跖趾关节巨大痛风石的近期临床疗效。方法 :自2015年1月至2016年12月,采用分期手术治疗第1跖趾关节巨大痛风石患者12例,全部为男性;年龄45～73岁;右足6例,左足6例;保守治疗2年以上,双能CT检查明确通风石大小及部位;经X线片检查均可见第1跖趾关节骨质破坏。所有患者Ⅰ期手术行痛风病灶的彻底清除及克氏针临时固定,待局部软组织条件稳定后再行跖趾关节的植骨融合内固定手术。比较手术前后血尿酸含量,患肢畸形矫正及并发症情况,采用VAS评分评价疼痛缓解程度。结果:所有患者顺利完成手术,且获得随访,时间9～13个月。12例患者VAS评分由术前的6～9分降低至术后7周的0～1分;血尿酸含量由术前的443～501μmol/L降低至术后7周的307～330μmol/L;术后5～7个月足部第1跖趾关节畸形矫正、外形恢复。术后1例发生切口感染、皮缘坏死,经清创及换药处理后切口愈合。结论:分期手术治疗足部第1跖趾关节巨大痛风石,可矫正关节畸形,恢复第1跖趾关节外形,改善患足疼痛,有利于控制血尿酸含量,且并发症少。     

微型锁定钢板关节融合术治疗足部痛风石性关节炎疗效分析

[目的]探讨采用痛风石切除+微型锁定钢板跖趾关节融合术治疗足部痛风石性关节炎的临床疗效。[方法]将2010年5月²013年3月间本院收治的21例患者(32足)采取痛风石切除+微型锁定钢板跖趾关节融合的患者临床资料进行回顾性分析。[结果]经随访,患者平均VAS评分为(2.4±0.6)分,患足平均AOFAS评分为(80.2±2.4)分,平均Tegner活动力评分为(4.3±0.9)分,较术前明显改善。1足出现手术切口皮缘坏死,其余伤口均一期愈合,1足手术部位出现痛风石复发。[结论]痛风石性关节炎易累及第1趾跖关节,严重影响足部功能及外观,单钠尿酸盐结晶沉积可造成进行性的关节退变及腐蚀,宜及早进行手术治疗。术中清除痛风石及沉积物,并以微型钢板对受累关节进行融合可取得理想的术后效果,在阻止骨质进一步侵蚀的同时,可提供稳定的固定效果。术中应注意保护局部皮瓣血运,术后进行积极的功能锻炼。     

手部痛风石的手术治疗体会

[目的]探讨手部痛风石的手术疗效及临床经验。[方法]对12例手部痛风石患者进行手术治疗,单纯痛风石切除10例,腕管切开正中神经松解、痛风石切除、指浅屈肌腱切除2例,术中采用5%碳酸氢钠溶液冲洗创面。术前及术后应用抗痛风药物。[结果]所有病例术后3周拆除缝合线,切口一期愈合,本组患者随访时间8个月⁶年,手术部位痛风石无复发,畸形得到纠正,手指感觉恢复,功能满意。[结论]手术治疗可及时阻断局部痛风的病理进程,可以改善手的外观和功能。术中应用5%碳酸氢钠溶液冲洗创面可以使手部痛风石的清除更容易、有效。     

痛风石诊断与治疗的研究进展

痛风石由尿酸及尿酸盐晶体沉积于外周骨及软组织而形成,常发生于四肢关节及皮下,其不仅影响局部外观还可破坏骨与关节结构,影响肢体的正常功能。传统经典药物治疗是控制高尿酸血症的必要措施,然而对于晚期痛风石,药物难以有效,手术治疗可清除痛风石,控制机体尿酸总量,改善局部功能,但其创伤较大且易复发。新型抗尿酸药物是目前研究热点,其除了对于控制血尿酸水平疗效显著外尚可溶解部分痛风石,但其费用较高。晚期痛风石最佳治疗方法目前仍存在争议。     

Intraosseous tophus deposits in the os trigonum

High levels of uric acid cause accumulation of monosodium urate crystals. This formation of masses is called tophus. Intraosseous tophus deposits are rare, even for patients with gout. We report an unusual case of intraosseous tophus deposits in the os trigonum. The patient presented with ankle pain with no previous history of gout. On examination, tenderness on the posterior aspect of his ankle and limitation of plantarflexion was noted. Laboratory values were normal, except for an elevated serum uric acid value. Radiographs of the right ankle showed the presence of a large os trigonum with osteosclerotic changes, whereas magnetic resonance imaging showed intraosseous tophus deposits in the os trigonum. Conservative therapy failed, and the patient was admitted for an endoscopic resection of the os trigonum.Intraosseous chalky crystals were detected during endoscopic resection of the os trigonum. The histological diagnosis was tophaceous gout. The underlying pathological mechanism of intraosseous tophi is uncertain. Penetration of urate crystals from the joint due to hyperuricemia may be the mechanism of deposition in this patient.When a patient with hyperuricemia presents with posterior ankle impingement symptoms, intraosseous tophus deposits should be included in the differential diagnosis. Posterior endoscopic excision may be an option for treating intraosseous lesions of the os trigonum because of good visualization, satisfactory excision, and rapid recovery time.     

Gouty Tophi in Sinus Tarsi of Bilateral Feet Mimicking Synovial Sarcoma:A Case Report

Chronic gout is defined as accumulation of monosodium urate crystals in joints, cartilage, tendons, bursae, bone, and soft tissue. The foot is the most common location for acute gout flares, with the first metatarsophalangeal joint being the most frequent site of tophus formation. However, few studies have reported gouty tophus formation in the subtalar joint. Gout has been termed the “great mimicker” because of its tendency to mimic other pathologic conditions, such as pigmented villonodular synovitis and synovial sarcoma. Herein, we present a rare case of chronic tophaceous gout in the sinus tarsi in both feet in a 23-year-old healthy male, with extensive bony erosions mimicking pigmented villonodular synovitis and synovial sarcoma. We discuss the clinical presentation, distinguishing radiologic characteristics, surgical procedures, and outcome regarding this unique presentation.     

When gout involves the spine: Five patients including two inaugural cases

Spinal involvement is uncommon during gout and may raise diagnostic challenges. We describe five cases seen at a single center.MethodsWe retrospectively reviewed the medical charts of the five patients with spinal gout seen over a 3-year period.ResultsThere were four men and one woman with an age range of 52 to 87 years. One patient presented with acute neck pain and visualization by imaging studies of a discovertebral tophus, another had febrile arthritis of a lumbar facet joint, and a third presented with a synovial cyst in a lumbar facet joint. The remaining two patients had acute febrile discitis confirmed by magnetic resonance imaging, at the cervical spine and lumbar spine, respectively. Laboratory tests showed systemic inflammation in four patients and marked serum uric acid elevation in two patients. Only three patients reported a previous history of peripheral acute gout attacks. Specimens of the spinal lesions were obtained in three patients and consistently showed monosodium urate crystals with tissue inflammation or a tophus. The outcome was rapidly favorable, either with colchicine therapy alone in four patients or after surgical resection of a facet joint cyst (during surgery to stabilize the lumbar spine) in the remaining patient. The patient with neck pain due to a tophus experienced nerve root pain at the acute phase. No other neurological manifestations were recorded.ConclusionThese case reports illustrate the diagnostic challenges raised by spinal involvement due to gout. The spinal lesions can be inaugural, as seen in two of our five patients.     

Ultrasonography for diagnosing atypical gout. Two case reports

Gout is characterized by the deposition of monosodium urate crystals on the surface of the articular cartilage, within periarticular tissues, and within bone and skin. The diagnosis rests on identification of the crystals in joint fluid or a tophus. However, joint aspiration is not always feasible, and the presentation may be atypical. We describe two cases of chronic gouty arthritis misdiagnosed as psoriatic arthritis. Ultrasonography of the bone and joints disclosed two patterns recently described as highly suggestive of gout, namely, the double-contour appearance of the cartilage and the snowstorm appearance of the synovial membrane. In addition, ultrasonography was useful for guided aspiration of joint fluid or other material containing monosodium urate crystals. Thus, ultrasonography may contribute to improve the diagnosis and treatment of gout.     

Endoscopic resection of the gouty tophi of the first metatarsophalangeal joint

Gouty tophus of the first metatarsophalangeal joint can cause shoewear problem. It can ulcerate and lead to secondary infections. Wound complications are common after open resection of the tophus. We describe an endoscopic approach to resect the tophus in order to minimize the soft tissue complications.     

Use of Masquelet’s technique for treating the first metatarsophalangeal joint in cases of gout combined with a massive bone defect

Background

To examine the safety and efficacy of Masquelet’s technique as a surgical method for treating the first metatarsophalangeal joint in cases of gout accompanied by a massive bone defect.

Multifocal metastases of recurrent renal cell carcinoma successfully treated with a combination of low dose interleukin-2, α-interferon and radiotherapy

A 59-year-old man presented with a 2-month history of left flank pain and a possibility of gross hematuria. Left renal cell carcinoma stage II was diagnosed and radical left nephrectomy was performed. Twenty-two months postoperatively, lung metastases were demonstrated and 6 x 10(6) units of alpha-interferon (IFN-alpha) were administered for 9 months, only to keep the sizes of the metastases unchanged. Thirty-four months after the operation, liver metastases and bone metastasis in the left sacroiliac joint were revealed. The combination cytokine therapy was performed with 1.4 x 10(6) U of interleukin-2 (IL-2) and 3 x 10(6) U of IFN-alpha for 16 weeks, and the left sacroiliac joint metastasis was treated with radiation therapy of 4 Gy per day for 7 days. Six months after the 16 weeks of immunotherapy, computed tomography and bone scintigraphy revealed that the metastases of the lung, liver and bone substantially disappeared and this complete response is still kept after 16 months.     

Large Osteochondral Defects of the Distal Tibia Plafond After Septic Arthritis of the Ankle Joint Treated by Arthrodiastasis and Iliac Bone Graft: A Case Report

Bone defects after septic arthritis of the ankle joint result in arthrodesis and severe loss of ankle motion. This must be prevented in young athletes. We report the case of a 17-year-old male patient with large osteochondral defects in the distal tibia plafond after septic arthritis, in whom iliac bone graft and arthrodiastasis were performed to preserve ankle motion. He was diagnosed with septic arthritis of the ankle joint postoperatively at the age of 16 years. After irrigation and hardware removal, C-reactive protein level was normal. However, he experienced continuous pain and could not walk; he was referred to our hospital. Computed tomography showed large osteochondral defects in the medial tibia plafond occupying ∼30% of the plafond articular surface. Simultaneous iliac bone block graft and arthrodiastasis with an external fixator were performed. We placed iliac bone graft into the defect in the medial tibia plafond using the anterior approach, and we placed an external fixator with hinge and tractioned and fixed the ankle joint. One week postoperatively, range of motion training of the ankle was started. We removed the foot ring at 3 months and the external fixator at 4 months postoperatively. The patient started jogging at 8 months and performing long jump at 1 year postoperatively. The Japanese Society for Surgery of the Foot ankle/hindfoot scale improved from 56 to 97 points at 2-year follow-up. Despite large osteochondral defects with septic arthritis, arthrodiastasis and iliac bone graft were beneficial for preserving the ankle joint and its function.